| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCINNES GROUP, INC.3 | 5201 JOHNSON DR SUITE 100 MISSION, KS 662052930 | RELIASTAR LIFE INSURANCE COMPANY | $7K | — | $7K | 1.01% |
| ASCENSION BENEFITS & INS. SOLUTIONS3 Filed as: ASCENSION INS SERVICES INC. | 1277 TREAT BLVD SUITE 650 WALNUT CREEK, CA 94597 | STANDARD INSURANCE COMPANY | $47K | — | $47K | 12.29% |
| ASCENSION BENEFITS & INS. SOLUTIONS3 Filed as: ASCENSION INS SERVICES INC | 1277 TREAT BLVD SUITE 650 WALNUT CREEK, CA 94597 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 11.02% |
| JEANETTE HUBER3 | 1099 E CHAMPLIAN STE A182 FRESNO, CA 93720 | HARTFORD LIFE AND ACCIDENT | $444 | — | $444 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMIN | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $305K |
| BLUE CROSS EIN 95-4331852 PPO/UR VENDOR | Float revenue; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $291K |
| MCINNES MAGGART CONSULTING EIN 48-1108277 BROKER | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $90K |
| MEDTRAK SERVICES EIN 36-4221427 RX VENDOR | Claims processing; Direct payment from the plan Service code 12 | — | $64K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 895 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 896 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY | 898 | $30K |
| Vision | VISION SERVICE PLAN | 933 | $131K |
| Life insurance | STANDARD INSURANCE COMPANY | 1,460 | $379K |
| Long-term disability | STANDARD INSURANCE COMPANY | 91 | $33K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 534 | $667K |
| Other | HARTFORD LIFE AND ACCIDENT | 13 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,460 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.